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US Ecology Nevaaa laeattyl usencscwuserAfty.com <br /> USEcology Idaho(Grandview) useics@usec .com PROFILE It <br /> USFcologPUS Ecology Texas(Robstown) usetcs@usecology.com <br /> WASTE PROFILE FORM US Ecology Michigan(Detroit) usemcs@usecology.com <br /> A. GENERATOR INFORMATION <br /> 1, Generator B&C Painting Solutions Inc ❑Billing information is same [1 P.O,required for payment <br /> 2. Facility Address 107 Val Dervin Pkwy,Stockton,CA 95206 12.Billing Company Fremouw Environmental Services, Inc <br /> 3. Mailing Address 107 Val Dervin Pkwy,Stockton,CA 9520 13,Billing Address 6940 Tremont Road <br /> 4. City/State/Zip 14.City/State/Zip Dixon,CA 95620 <br /> 5. Technical Contact Gary 15.Billing Contact Dina/Pat/Phil <br /> 6. Phone (209) 982-0422 7. Fax 16.Phone (707)448-3700 17.Fax (707)448-3499 <br /> 8. Generator Status ❑CESQG ®SQG ❑LQG 18.Email ap@hazwasteremoval.com <br /> 9. EPA ID#CAL 000 251 953 10.State ID# <br /> 11. SIC Codes: 1721 <br /> B. SHIPPING INFORMATION <br /> 1. US DOT Shipping name:Non-Hazardous Waste Solid/Sand Blast Media <br /> 2. Hazard Class: N/A 3. UN/NA#: N/A 4. Packaging Group: N/A 5. RQ: N/A <br /> 6. Container Type ❑Bulk ❑Totes ❑Pallet ❑Boxes ®Drums ❑Other,Describe: <br /> 7. Frequency ❑Year Quarterly ®Monthly ❑ 1 time ❑Other,Describe: <br /> 8. Shipment Size: 55 Quantity: 1 -5 9. Waste Import Yes 21 No <br /> ! es,complete Waste Import Supplement <br /> C. GENERAL MATERIAL&REGULATORY INFORMATION <br /> 1. Common name forth is waste: <br /> Sand Blast Media/Analytical attached <br /> 2. Process generating the material: <br /> operating Procedures <br /> 3. Describe physical appearance and odor of the waste: <br /> Solid/Varies <br /> 4. Odor of the waste ® None ❑Slight ❑Strong 5. Physical State: ❑Liquid ❑Sludge/Slurry ®Solid <br /> 6. Describe Color: varies 1 7. Liquid phases: ❑Single ❑Double Layer ❑Multi-layer <br /> 8. Knowledge is from ®Lab analysis ❑MSDS ®Process/generator knowledge <br /> 9. Waste Type(US EcologyTexas customers only): ❑ industrial ❑Non-Industrial <br /> 10. Is the waste restricted under EPA Land Disposal Restrictions(§268) ❑Yes ®No <br /> 11. If LDR"Yes",is waste: ❑Wastewater ❑Non-wastewater ❑Debris(§268.2) 12. Alt.Standards for soil? ❑Yes ❑No <br /> 13. Is the waste RCRA hazardous waste containing benzene and originating at a Petroleum Refinery(SIC 2911),Chemical <br /> Manufacturing Plant(SIC 2800 thru 2899)or Coke by-Product Recovery Plant(SIC 3312)? (If"Yes"complete Benzene ❑Yes ®No <br /> Waste Operations Supplement form) <br /> 14. VO Conc.(§264.1083) ®<500 ppmw ❑z500ppmw 15. Has waste been treated after point of generation? ❑Yes ®No <br /> 16. CERCLA Regulated(Superfund)Waste ❑Yes ®No 17. Butadiene waste regulated by 563 Subpart XX ❑Yes ®No <br /> 18. Waste contains UHC constituents)(§268.48),above a treatment standard,other than those for which the waste ❑yes ®No <br /> exhibits a characteristic. (If"yes",list all UHC's in Section D) <br /> 19. Waste exempt from definition of"solid waste"or"hazardous waste" (if"Yes",list reference 40CFR ) ❑Yes ®No <br /> 20. State Waste Codes NIA <br /> 21. RCRA Waste Codes NIA <br /> 22. Source Code: G 23. Form Code: W 24. Management Code: H <br /> Revision date:.5/7/2013 Page 1 <br />